Acid Reflux During Pregnancy: Causes and Treatments

Gastroesophageal reflux disease (GERD) occurs in up to 50 percent of pregnant women. Whether you are pregnant or not, GERD can occur when there is an increase or decrease in pressure on different parts of your esophagus and abdomen. The source of the pressure, however, is different in pregnancy than in non-pregnancy.

How pregnancy changes GERD

The two major factors that promote acid reflux in pregnant women are changes in hormones and the growing baby. Changes in levels of estrogen and progesterone result in a decrease in pressure on a part of your body called the lower esophageal sphincter, thereby increasing acid reflux. Additionally, the growing baby causes an increase in what is called intra-abdominal pressure, resulting in an increase in the development of reflux. Excess pregnancy weight gain can also make the problem worse, particularly in the third trimester.

Is it just GERD?

In general, the likelihood of having any symptoms of heartburn or regurgitation increases as pregnancy continues. Knowing which symptoms you have is important when talking about prevention and treatment. For example, according to one study, 45.5 percent of pregnant women studied had GERD, 13.5 percent had regurgitation alone, 19.3 percent had heartburn alone, and 12.8 percent had both heartburn and regurgitation. Women may also have a difficult time distinguishing the difference between GERD and symptoms of pregnancy, like morning sickness, particularly in the first trimester.

How food choices can help prevent GERD

Lifestyle changes are the most common ways that you can prevent increases in intra-abdominal pressure and decreases in lower esophageal sphincter pressure that promote reflux during pregnancy.

The most frequently suggested changes include eating smaller meal portions which will decrease the amount of food in the stomach. By eating smaller, more frequent meals, you may be able to reduce reflux symptoms while still maintaining a healthy weight.

Doctors might also recommend that you avoid certain activities immediately after eating. For example, avoid lying down for at least an hour to allow your food to digest. Some pregnant people also have issues if they exercise too close to mealtime. If you find that these activities lead to more symptoms, plan accordingly.

Your food choices can play a large part in how many reflux symptoms you experience. Eating spicy foods, for example, can increase the likelihood of a flare-up, while eating green vegetables may help reduce symptoms or prevent attacks.

Other lifestyle changes can relieve GERD symptoms

Gravity plays an important role in controlling reflux, so elevating the head of your bed might help. When a person is lying flat on their back, stomach contents are more likely to reflux into the esophagus. Studies have documented that, as compared with patients who sleep flat on their backs, patients who elevate the head of the bed have significantly fewer reflux episodes, and the episodes that do occur are shorter and generally produce milder symptoms.

Medical treatment of GERD in pregnancy

GERD symptoms can occur in all three trimesters. About 26 percent of women report symptoms in the first trimester, 36 percent in the second trimester, and 51 percent in the third trimester. Given that the development of your fetus is different in every trimester, it may be important to consider which trimester you are in and how well your symptoms are controlled without medication before looking to these treatments.

One of the biggest issues with GERD is that most women do not experience significant relief from treatment, and this includes prescription medications. This is one reason that prescriptions are used infrequently and why prevention is key.

Over-the-counter antacids are the most frequent method for controlling symptoms, and they're among the safest of medications as well. H2 blockers and proton pump inhibitors (PPIs) are other medications that can treat GERD symptoms in pregnancy.

PPIs are used in non-pregnant women with great success. They are considered safe in pregnancy with no significant increased risk of major birth defects, even when used in the first trimester. So, in the absence of other risk factors, and no pain relief from traditional over-the-counter methods, a medication like Omerparzole is considered a viable option.

In most cases, acid reflux is easily treated, even in pregnancy. If there are symptoms that don’t respond well to treatment, that can result in complications such as gastrointestinal bleeding, difficulty swallowing, or weight loss. If this happens your midwife or obstetrician may refer you to a gastroenterologist. Also be aware that other conditions such as gallbladder disease, pancreatitis, or even cancers of the esophagus and stomach can mimic gastroesophageal reflux disease, although these are far less common.

Robin Elise Weiss, Ph.D., LCCE, CLC, AdvCD(DONA) is a childbirth educator, doula, founder of Childbirth.org, and the award-winning pregnancy and parenting author of “The Complete Illustrated Guide to Pregnancy” and more than 10 other books. Between her nine children, teaching childbirth classes, and attending births for more than two decades, she has built up an impressive and practical knowledge base. You can follow Robin on Twitter @RobinPregnancy, Instagram, and Facebook.